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Cautionary note about prostates

Rating

4 Star

Cautionary note about prostates

Our Review Summary

First, kudos to the Baltimore Sun for affording this piece almost 1,000 words at a time when many health news stories are limited to 300 words.   This is a thoughtful story reporting on the results of a recent study which found that the use of hormone therapy in the treatment of localized prostate cancer in older men was not beneficial.  

Particular strengths of the story include:

  • Terrific interview segments with the lead author and with two urologists.
  • The perspective that some urologists may have once seen a "financial windfall" in the use of hormone therapy, explaining some of the expansion in its use.  

One weakness:

  • The story could have (should have?) added the important point that screening for prostate cancer is not proven effective yet and remains controversial.  One of the reasons so many elderly men are thrown into this difficult decision-making thicket is that the use of the PSA blood test has led to many men being diagnosed with prostate cancers of unknown significance, and leading many of them to pursue the hormone therapy that they felt rendered benefit without side effects.  Bottom line of this study:  that theory was wrong.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Although the story mentioned that this treatment was a profit center for some clinicians, it did not provide information about the costs to consumers.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story was crystal clear about the lack of benefit from the use of hormone therapy to treat older men with localized prostate cancer in terms of overall survival or risk of death from prostate cancer.  The story was very complete and then included information about the subset of patients – those older men with localized prostate cancer with a more aggressive cell who comprised about 5% of the study population and appeared to derive some benefit in terms of reducing the number that died of prostate cancer but still without enhancement of overall survival.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

While not indicating frequency of occurrence (except for loss of sexual function which was reported to occur in all individuals), the story listed the side effects known to occur as a result of this treatment. 

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story mentioned that the study reported on was to be published in the Journal of the American Medical Association. It also mentioned that the study used information from a database to derive its conclusions.  But it could have commented on how this type of evidence stacks up in the hierarchy of evidence.  Not all studies and study types are equal and journalists should begin educating readers about the differences in the quality of the evidence. Again, a jump ball call, but we’ll give the story the benefit of the doubt.

Does the story commit disease-mongering?

Not Satisfactory

 There is no overt disease mongering.  But there are some subtle undertones thereof.  If the story is to include data about the number of deaths attributable to prostate cancer, it could tell another important side of the story.  In the era of rampant use of the PSA blood test — essentially a man’s lifetime risk of being diagnosed is about 16% (because of increased detection with PSA screening), but his lifetime risk of dying of prostate cancer is only about 3%.  These numbers should be very reassuring to men in that most men are not destined to die of their prostate cancer.  In addition, we still do not know if all this screening (and increased detection of prostate cancer) is doing men any benefit, as the effectiveness of prostate cancer screening in terms of survival benefit remains uncertain.

But because the story drove home the point early that there is new doubt about "the the common public perception that doing something for cancer is always better than doing nothing," we’ll give the story the benefit of the doubt. 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

This story included quotes from two clinicians in addition to an author of the study reported on. Although the story did not indicate, the two additional clinicians did not seem to have ties to the study reported on.

Does the story compare the new approach with existing alternatives?

Satisfactory

This story did an admirable job laying out for readers that not taking action, in the case of the older patient with localized prostate cancer, was, in fact, a better approach than the treatment.  While overall survival did not differ between the groups, those that did not have the treatment would not be at risk of the side effects of the treatment.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

This story indicated that the treatment was "popular" and was available from urologists.

Does the story establish the true novelty of the approach?

Satisfactory

The story explained that hormone therapy had been used for some time for treatment of prostate cancer which has spread beyond the prostate where there is evidence demonstrating benefit.  It was also clear that since the 1990s urologists "have expanded the use" to treat localized prostate cancer.  

Does the story appear to rely solely or largely on a news release?

Satisfactory

Does not appear to rely on a press release.

Total Score: 8 of 10 Satisfactory

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